Personality disorders in patients with eating disorders in Japan

The use of a mnemonic cueing system (NeuroPage) and a paper and pencil checklist in the rehabilitation of executive problems in a 50-year-old woman are described. Following a CVA 7 years earlier, the patient, despite intact general intellectual and memory functioning, had specific executive impairments of attention, planning, realizing intended actions, and also exhibited behavioral routines similar in form to obsessive-compulsive rituals. In a series of ABAB single-case experimental designs, the efficacy of 2 external cueing systems in prompting appropriately timed action is demonstrated. It is argued that the combination of external control and increased sustained attention to action were critical to the success of NeuroPage with this patient. Furthermore it is hypothesized that the checklist was effective in facilitating the patient's ability to foresee and recognize the consequences of her actions, which in turn had an impact on the probability of her changing those same actions.     

Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood.

Longitudinal data were used to investigate whether anxiety, depressive, disruptive, personality, or substance use disorders are associated with risk for the development of eating disorders during adolescence or early adulthood. Psychiatric disorders were assessed among 726 youths from a random community sample during adolescence and early adulthood. Depressive disorders during early adolescence were associated with elevated risk for the onset of eating disorders, dietary restriction, purging behavior, and recurrent weight fluctuations after preexisting eating problems and other psychiatric disorders were controlled statistically. Disruptive and personality disorders were independently associated with elevated risk for specific eating or weight problems. The present findings suggest that depressive disorders during early adolescence may contribute to the development of eating disorders during middle adolescence or early adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactive effects of menarcheal status and dating on dieting and disordered eating among adolescent girls.

The effects of menarcheal status and opposite-sex socializing (mixed-sex social activity, dating, and noncoital sexual involvement with boyfriends) on dieting and disordered eating among early adolescent girls are examined. In all, 89 12- and 13-year-old girls reported their menarcheal status, dieting behaviors and attitudes, and involvement in dating and other heterosocial activities. Girls who are more involved in mixed-sex social activities are more likely to exhibit disordered eating tendencies, and this effect is stronger among girls who have experienced menarche. Also, girls who are dating and are more physically involved with boyfriends are more likely to report dieting and disordered eating than are their peers. An interaction between dating and menarcheal status was observed in the prediction of dieting and disordered eating, with dating more strongly linked to dieting and disordered eating among girls who have recently experienced menarche. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders in patients with eating disorders: a controlled study

A group of 24 eating-disordered female subjects (10 anorexia nervosa--AN--and 14 bulimia nervosa--BN--patients) were interviewed, using a semistructured interview for DSM-III-R Axis-II Personality Disorders (SCID-II). A group of 54 subjects without eating disorder acted as a control group. A high rate of personality disorder (PD) diagnoses occurred in eating disordered subjects (AN and BN patients), with a high prevalence of borderline, dependent, and self-defeating PD. Avoidant and obsessive-compulsive PD were more common in AN patients, whereas BN was associated with histrionic PD. Findings have implications for the assessment and diagnosis of eating-disordered patients and for treatment planning.     

Development of eating problems in adolescent girls: A longitudinal study.

Examined the emergence of eating problems in adolescent girls as a function of pubertal growth, body image, personality development, and family relationships. 193 White females and their mothers were seen in middle-school years (M age?=?13.93 years) and 2 years later. Results showed that girls who early in adolescence felt most negatively about their bodies were more likely to develop eating problems (on EAT-26) 2 years later. Concurrently, Time 1 eating problems were associated with body fat, grade, negative body image, and psychopathology, but not family relationships. At Time 2, adolescent body image and internalizing dimensions of psychopathology predicted problem-eating scores, as did maternal body image and depression. Findings are discussed in terms of adolescent patterns of adaptation, developmental psychopathology, and the study's relevance for understanding clinical eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic risk factors for disordered eating in adolescent males and females.

The etiologic role of genetic and environmental factors on disordered eating was examined in a sample of 15- to 17-year-old female–female, male–male, and opposite-sex twin pairs. Also assessed was whether a single factor is underlying 3 facets (body dissatisfaction, drive for thinness, bulimia) of disordered eating, including the possible importance of sex differences. Univariate model-fitting analyses indicated that genetic factors are more important for girls and environment more important for boys for body dissatisfaction and drive for thinness. A multivariate common factor analysis indicated that a single factor accounted for the association among these 3 facets of disordered eating in both sexes. However, only 50% of the genetic risk for this factor is shared between the sexes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality features and expressed concerns of adolescents with eating disorders

Differences between adolescent females diagnosed with either anorexia nervosa (n = 26) or bulimia nervosa (n = 30) were investigated using the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982). About half of the total sample displayed an inhibited (avoidant) personality style. Anorexics scored higher than did bulimics on the Respectful (Compulsive) personality scale. Expressed concerns over self-concept, personal esteem, and sexual acceptance were common in the total sample. The behavioral correlates of MAPI score profiles indicated that few bulimics, and none of the anorexics, were likely to exhibit problems with impulse control, societal conformity, and scholastic achievement. Results are compared with clinical observations of adolescents with eating disorders and findings for adult eating-disordered samples.     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls.

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N?=?496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating.

This article presents the 2-year findings of a prospective investigation of the precursors to the later development of an eating disorder in adolescents. The sample consisted of 852 girls and 815 boys who began the study in Grades 7–10 and participated for 3 consecutive years. For both genders, the strongest predictors of Year 3 risk status were Years 1 and 2 risk scores. When the effects of Year 1 and Year 2 risk were controlled, race (Caucasian) and poor interoceptive awareness at Year 2 were significant predictors of disordered eating at Year 3 for girls. Previous risk status was the only significant predictor of Year 3 risk for boys. Gender difference evaluations in the risk score components indicated that a significantly greater proportion of girls than boys endorsed behaviors that were similar to eating disorder diagnostic criteria. Poor interoceptive awareness may provide a vulnerability for eating disorders; possible pathways were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls.

One's expectancies for reinforcement from eating or from thinness are thought to represent summaries of one's eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation.

Because little is known about the predictors of binge eating (a risk factor for obesity), a set of putative risk factors for binge eating was investigated in a longitudinal study of adolescent girls. Results verified that binge eating predicted obesity onset. Elevated dieting, pressure to be thin, modeling of eating disturbances, appearance overvaluation, body dissatisfaction, depressive symptoms, emotional eating, body mass, and low self-esteem and social support predicted binge eating onset with 92% accuracy, Classification tree analysis revealed an interaction between appearance overvaluation, body mass, dieting, and depressive symptoms, suggesting qualitatively different pathways to binge eating and identifying subgroups at extreme risk for this outcome. Results support the assertion that these psychosocial and biological factors increase risk for binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy with high-achieving adolescent girls.

The "overnurtured child" is the label applied to adolescent girls whose strong mother-identification and oedipal attachment to father may be associated with a variety of achievement-related conflicts following puberty. Symptoms include anxiety, depression, vague feelings of inadequacy, loneliness, and isolation from peers. These patients suffer from a form of identity diffusion in which pressures to continue achieving at their present rate of excellence collide with pressures to be more "feminine," social, and affiliative. Therapy is conceptualized as a kind of resocialization process aimed at facilitating separation from family and the development of an independent identity. In treatment, the therapist plays a variety of interrelated roles such as role model, family counselor, and teacher. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7, SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than did those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of eating problems: An 8-year study of adolescent girls.

Little prospective work has charted the onset and predictors of subclinical or clinical eating problems. Eating problems were studied in 116 adolescent girls drawn from a normal population of students enrolled in private schools in a major metropolitan area who have been followed longitudinally over an 8-yr period from young adolescence to young adulthood. Over a quarter of the sample scored above the level identifying a serious eating problem at each of the 3 times of assessment. Examination of the adolescent pattern of eating problems over young and mid-adolescence indicated that pattern was associated with (1) earlier pubertal maturation and higher body fat, (2) concurrent psychological disturbances, (3) subsequent eating problems, and (4) other long-term adjustment outcomes such as depressive affect in young adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Iron status, menarche, and calcium supplementation in adolescent girls

The effects of growth, menstrual status, and calcium supplementation on iron status were studied over 4 y in 354 girls in pubertal stage 2 who were premenarcheal at baseline (x+/-SD age: 10.8+/-0.8 y). Girls were randomly assigned to placebo or treatment with 1000 mg Ca/d as calcium citrate malate. Anthropometric characteristics, bone mass, and nutritional status were measured biannually; ferritin was measured annually; and red blood cell indexes were determined at 4 y. The simultaneous effects of iron intake and menstrual status on serum ferritin, after change in lean body mass (LBM) was controlled for, were evaluated in subjects in the upper and lower quartiles of cumulative iron intake. The average maximal accumulation of LBM (386 g/mo; 95% CI: 372, 399) occurred 0.5 y before the onset of menarche. Change in LBM was a significant predictor of serum ferritin (P < 0.0001), with a negative influence on iron status (t ratio=-4.12). The 2 fitted mathematical models representing ferritin concentrations of subjects in the upper and lower quartiles of cumulative iron intake were significantly different (P < 0.018). The regression line of the ferritin concentration in menstruating girls with high iron intakes had a less negative slope than the line fit to serum ferritin concentrations in girls with low iron intakes (NS). Serum ferritin concentrations at 0, 1, 2, 3, and 4 y were not significantly different between groups. In addition, there was no significant difference between groups in any of the red blood cell indexes. In summary, growth spurt and menstrual status had adverse effects on iron stores in adolescent girls with low iron intakes (<9 mg/d), whereas long-term supplementation with calcium (total intake: approximately 1500 mg/d) did not affect iron status.     

Effectiveness of an Internet-based program for reducing risk factors for eating disorders.

This study evaluated an Internet-delivered computer-assisted health education (CAHE) program designed to improve body satisfaction and reduce weight/shape concerns—concerns that have been shown to be risk factors for the development of eating disorders in young women. Participants were 60 women at a public university randomly assigned to either an intervention or control condition. Intervention participants completed the CAHE program Student Bodies. Measures of body image and disordered eating attitudes were assessed at baseline, postintervention, and 3-month follow-up. At follow-up, intervention participants, compared with controls, reported a significant improvement in body image and a decrease in drive for thinness. This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for depression prevention: Identifying adolescent girls at high risk for future depression.

This study investigated a broad array of putative risk factors for the onset of major depression and examined their screening properties in a longitudinal study of 479 adolescent girls. Results indicated that the most potent predictors of major depression onset included subthreshold depressive symptoms, poor school and family functioning, low parental support, bulimic symptoms, and delinquency. Classification tree analysis revealed interactions between 4 of these predictors, suggesting qualitatively different pathways to major depression. Girls with the combination of elevated depressive symptoms and poor school functioning represented the highest risk group, with a 40% incidence of major depression during the ensuing 4-year period. Results suggest that selected and indicated prevention programs should target these high-risk populations and seek to reduce these risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing readiness for change in adolescents with eating disorders.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of social skills in delinquent and nondelinquent adolescent girls using a behavioral role-playing inventory.

Delinquent behavior in adolescent girls may be related to deficits in social skills; that is, some girls may behave maladaptively because they lack the skills to perform more competently. During the 1st phase of this research, the Problem Inventory for Adolescent Girls (PIAG) was developed to measure competence in social situations. The 2nd phase of the research compared the performance of carefully matched groups of 29 delinquent and 29 nondelinquent girls (mean age 16.25 yrs) on the inventory. The PIAG significantly discriminated between the groups; 40 of the 52 individual items also discriminated between the delinquent and nondelinquent Ss. 10 of the 12 nondiscriminating items were those for which the criteria had been developed by teenagers. This suggests that delinquency is more closely related to skill deficits in interacting with adult authority figures than to skill deficits with peers. Items on the inventory generally were independent of one another and lacked an interpretable clustering pattern. A discriminant analysis yielded a function that resulted in 85% of the Ss being correctly assigned to their appropriate delinquent or nondelinquent group on the basis of their performance on the inventory. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for eating disorders.

The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances in understanding the etiology of eating disorders require a new generation of studies that integrate these domains. They discuss how more sophisticated and novel conceptualizations of risk and causal processes may inform both nosology and intervention efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)